Naloxone — a pharmaceutical drug used to reverse the effects of opioid overdose — has been used in emergency medicine (e.g. ambulance crews, hospital emergency-room teams) for over 40 years (1). As many overdoses occur in the presence of drug users' family members or peers, however, empowering bystanders to act effectively, before emergency services arrive at the scene, can save lives (2).

Following pilot initiatives in the 1990s, measures to scale up naloxone availability to those likely to witness an overdose have emerged in the last decade. This has been driven partly by the epidemic of opioid-related deaths (heroin and non-heroin) in the USA (3).

Analysing 21 studies conducted in four countries — Canada, Germany, UK and the USA — today’s review examines the latest evidence on the role of take-home naloxone (THN) in reducing opioid overdose fatalities. It concludes that THN provision, delivered with educational and training interventions, can be effective in reducing overdose-related deaths and improving knowledge on the signs of overdose and the correct management of patients.

Listed by the World Health Organization (WHO) as an ‘essential medicine’, naloxone is available in injectable form, with non-injecting administration also under investigation. Programmes and trials with THN distribution are currently run in seven European countries: Denmark, Germany, Estonia, Spain, Italy, UK and Norway (Annex 3 of review). Since September 2013, Estonia has offered a naloxone programme to tackle the sharp rise in deaths caused by illicit use of the synthetic opioid fentanyl. In 2014, Norway began a pilot of a nasal spray naloxone programme.

The report shows how evidence supports THN provision as part of a comprehensive harm reduction response (Figure 2). WHO guidelines on community-based naloxone provision were launched in November 2014 and a number of European countries have now developed national guidelines. Knowledge exchange on THN is important to allow potential implementers to take informed decisions (4).

Drug use is one of the major causes of mortality among young people in Europe. Overall, some 6 100 overdose deaths were reported in Europe in 2013. Substances associated with the risk of overdose include: opioids (non-medical or prescribed); benzodiazepines and synthetic opioids (e.g. fentanyls).

Naloxone — a pharmaceutical drug used to reverse the effects of opioid overdose — has been used in emergency medicine (e.g. ambulance crews, hospital emergency-room teams) for over 40 years (1). As many overdoses occur in the presence of drug users' family members or peers, however, empowering bystanders to act effectively, before emergency services arrive at the scene, can save lives (2).

About the EMCDDA

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU’s decentralised agencies. Read more >>